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'F Z_c, /Z_ a c-'t • S 1 rti Le-$ Go n nt I t •Fcre�, 6 52 9 s90 l 9 FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. PROTECTED PROPERTY INFORMATION Name ofproperty:_DM. l,l^Co( n�er∎Tegi0IQ1(oOLIS) Sir 300 Address: , e r Se n 4 ' t e t t . e ra n (0 300 Sts.! G recrt L v r c Ti 3 A rd q 7 2Z3 Description of propert OFFI ct Sp/ c ( e �` Occupancy type: �- 8V S I A A.11 - SS \S CO V e . Name of property representative: 51...o e.r 1e j n 21-AL t 7 7 5QrJ ic& S Address: /042-0 ..5t,,) Grtcn by r R.d II 7 /34rrvi 9 7zZ3 Phone: Fax: / E -mail: Authority having jurisdiction over this property: C T T 0P Ti 5 A rd Phone: Fax: E -mail: 2. FIRE ALARM SYSTEM INSTALLATION, SERVICE, AND TESTING INFORMATION Installation contractor for this equip ent: . To Pe...T E Ie. CT c t c n Address: 19 0 9 6E �G h o co Sr. /VI / L 9 u /C / k) e g 722 Z Phone: 503 - G y 2- - 65 Fax: 503 66 - '19 6 9 E -mail: Service organization for this equipment: Address: Phone: Fax: I E -mail: Location of as -built drawings: STo /le. r e le-t'r r t C. Location of historical test reports: Location of system operation and maintenance manuals: SLo're A ire t n . ShOre/n In A contract for test and inspection in accordance ith NFPA standards is in effect as of Contracted testing company: V n k A JT Tab. Address: Phone: Fax: E -mail: Contract expires: Contract number: Frequency of routine inspections: 3. TYPE OF FIRE ALARM SYSTEM OR SERVIC NFPA 72 Chapter Reference of System Type: Name of organization receiving alarm signals with phone numbers (if applicable): Alarm: Phone: Supervisory: Phone: Trouble: Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission of alarms to that organization or location: Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright 02002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. 0 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.1 of 5) • NATIONAL FIRE ALARM CODE 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE (continued) If Chapter 8, note the means of transmission from the protected premises to the central station: X Digital alarm communicator ❑ McCulloh ❑ Multiplex 0 2 -way radio 0 1 -way radio ❑ N/A If Chapter 9, note the type of connection: 0 Local energy 0 Shunt U N/A 3.1 System Software Operating system (executive) software revision level: �^ 11 � Site - specific software revision date: Revision completed by: JI tv e k.s Gri n nc 1 1 4. SIGNALING LINE CIRCUITS Characteristics of signaling line circuits connected to this system (see NFPA 72, Table 6.6.1): Quantity: Cc Style: 1 A Class: 1J /A 5. ALARM - INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: A Style: �/ A Class: //q 5.1 Manual initiating devices 5.1.1 Manual Pull Stations Number of manual pull stations: 0 Type of devices: 0 Addressable 0 Conventional ❑ Coded 0 Transmitter A N/A 5.2 Automatic Initiating Devices /� 5.2.1 Area Smoke Detectors Number of smoke detectors: �V Type of coverage: 0 Complete area 0 Partial area 0 Nonrequired partial area XN /A Type of devices: ❑ Addressable 0 Conventional 0 Coded 0 Transmitter J$fN /A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: 0 Type of coverage: Type of devices: ❑ Addressable 0 Conventional ❑ Coded U Transmitter XN /A Type of smoke detector sensing technology: 0 Ionization ❑ Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area N/A Type of devices: 0 Addressable ❑ Conventional 0 Coded 0 Transmitter XN /A 5.2.4 Sprinkler Watertlow Detectors Number of waterflow detectors: Type of devices: 0 Addressable 0 Conventional ❑ Coded ❑ Transmitter •/A 5.2.5 Alarm Verification N'/ Number of devices subject to alarm verification: Alarm verification on this system is: 0 Enabled ❑ Disabled ❑ Set for seconds Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright 02002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. ® 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.2 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS 6. SUPERVISORY SIGNAL - INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded ❑ Transmitter XN /A 6.2 Fire Pump 0/ Type of fire pump: 0 Electrical ❑ Diesel Type of pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded 0 Transmitter ,'N /A Fire Pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel I Other: " /A 6.3 Engine Driven Generator WA Type of generator supervisory devices: 0 Addressable ❑ Conventional ❑ Coded ❑ Transmitter XN /A ❑ Engine or control panel trouble ❑ Generator running 0 Selector switch not in auto 0 Low fuel Other: lam' //i 7. ANNUNCIATORS 0/A 7.1 Annunciator 1 0 Local ❑ Remote Type: ❑ Addressable ❑ Directory 0 Graphic 'N /A Location: 7.2 Annunciator 2 U Local 0 Remote Type: 0 Addressable 0 Directory ❑ Graphic XN /A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable 0 Directory ❑ Graphic XN /A Location: 8. ALARM NOTIFICATION DEVICES AND CIRCUITS '7 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: Number of multiple voice alarm channels: Y Number of speakers: $ Number of speaker zones: la 8.2 Telephone Jacks 1 Number of telephone jacks installed: 0 Number of telephone handsets stored on site: 0 Type of telephone system installed: ❑ Electrically powered ❑ Sound powered XN /A 8.3 Nonvoice Audible System Characteristic f notification vice circuits connected to this system (see NFPA 72, Table 6.5): Quantity: I E xi e nAta Style: 9 Class: B Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright 02002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. 0 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.3 of 5) NATIONAL FIRE ALARM CODE 8. ALARM NOTIFICATION DEVICES AND CIRCUITS (continued) C A EXIST"" 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With visual device Horns:(1) ei With visual device: (I ) Chimes: With visual device Bells: With visual device: Visual devices without audible devices(3) ,f Other (describe): 9. EMERGENCY CONTROL FUNCTIONS ACTIVATED 1\1/H ❑ Hold -open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ❑ Other 10. SYSTEM POWER SUPPLY 10.1 Primary Power t x ST I Nominal voltage Amps Overcurrent protection: Type Amps Location (of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: Type: Nominal voltage: Current rating: Number of standby batteries: c 2 Amp hour rating: Location of emergency generator: X I ST I n m Location of fuel storage: F X I ST I r` S Calculated capacity of seco dary power to drive the syste In standby mode: pc). IN 0 `) e S - Fo I towel II 1 In alarm mode: C ONO n" re- 11. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens, shorts, ground faults, and improper branching, but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) NFPA 72 NFPA 70, National Electrical Code, Article 760 di Manufacturer's published instructions ❑ Other (please specify): System deviations • m referenced NFPA standards: ,, --\\ .� // Signed: l�.J Printed name: W? � Date: '7— z4 `?- Organization: _ . iI r r i • Title: � uj- Phone: 40,3 y6A 12. RECORD OF SYSTEM OPERATION All operational features and functions of this system were tested by or in the presence of the signer shown below, on the date shown below, and were found to be operating properly in accordance with the requirements of: ❑ NFPA 72 ❑ NFPA 70, National Electrical Code, Article 760 ,Manufacturer' published instructions ' Other (please specify): brlwl r3 S 5 Cl F I CA Tt on S ❑ Documents i ccordance with Inspection and Testing Form Fi ure 10.6.2.3) is attached Signed: Printed name: Date: S' ) TS � I 7 -2 (0- (L � Organization: 1 Wt (�\ �i r t n of_ t` Title: J R Tceh 12f. Phone: CO3 - 6 R3 - 9 00 Reprinted with permission from NFVA 72, National Fire Alarm Code®, Copyright 02002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. © 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.4 of 5) FUNDAMENTALS OF FIRE ALARM SYSTEMS 13. CERTIFICATIONS AND APPROVALS 13.1 System Installation Contractor This system as spec ied herein has been installed and tested according to all NFPA standards cited herein. Signed: t6 Z Printed name: t.C) 6 C'1 Date: 7 L (' ?3 - 1 /6 - 6.560 Organization: -- �TQ��C' r�� -`t►V� Title: F�l"ZWIA� Phone: 6 13.2 System r 'ce Contractor This system -d herein has been installed and tested accor g to all NFPA standards cited herein. S Signed: Printed name: S ] w R TS k ) Date: 7- L6 Z Organization: I en plot Q r i n n2 l( Title: S Q • 7 c. k lee P. Phone: 5 - 6 8 3- 9 000 13.3 Central Station This system as specified herein will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.5 Authori., suing Jurisdiction I have witne . a satisfactory acce f • ce test of this system and find it to be installed and operating properly in accords with it • • • . ved pl • s and specifications, its approved sequence of operations, and with all NFPA standards i d herein. [ _ Signed: ted name: (1P L Date: r 7 -26- j Organization: r ",1-7/ cv- ' l,inAie+� Title;1.r■ihc_l);•Jcr. lAAS. Phone:. S 7i6 -Z ‘7 y 1S (AOGv r aue..r4 o/1� � 1 eSC C /'cv t TS y q .e■ A-5 5 kown A 61tyL)c GSrtnne II F itt, kit, (WI cirotwit"5 a tS, TG d 7 -16- r m)c` r g6cZ 95901 P G Qrc .� oc,�T�n�.s of NR Lincoln ( . S� (Tc ado, Reprinted with permission from NFPA 72, National Fire Alarm Code®, Copyright 02002, National Fire Protection Association, Quincy, MA 02169. This reprinted material is not the complete and official position of the National Fire Protection Association on the referenced subject which is represented only by the standard in its entirety. 0 2007 National Fire Protection Association SG24 -2 -014 Rev. (10/07) (p.5 of 5)